Providing Oxygen to a Dying Patient

WASHINGTON, D.C., 19 MAY 2010 (Zenit.org).- Here are two
questions on bioethics asked by ZENIT readers and answered by
the fellows of the Culture of Life Foundation.

The March 31 column "AIDS and the Spousal Use of Condoms"
elicited this response from a reader:

Q: My question relates to the situation where one of a married
couple has AIDS. The person with AIDS wishes to have sexual
intercourse with his/her spouse. Is it licit for the spouse
without AIDS to refuse the marriage act?

I have had had two answers to this from educated Catholics
—
one is "no" and one is "yes." It is not a question of using
condoms or anything pertaining to this. Simply for the sake of
the spouse saving his/her life, is it morally licit to refuse
the conjugal act even if the other wants it? Best wishes, W. L.;
Sydney, Australia

William E. May and E. Christian Brugger offer the following
response.

A: In our opinion an uninfected spouse is not required to have
intercourse with his or her infected spouse if there is good
reason to avoid intercourse. Allow us to explain.

In 1 Corinthians 7:3, St. Paul speaks about the "conjugal
rights" of spouses when he says: "the husband should give to his
wife her conjugal rights, and likewise the wife to her husband."
Catholic moral tradition has consistently affirmed the
importance of spouses generously rendering to one another the
"conjugal debt." Why is willingness to have intercourse with
one's spouse a duty? St. Paul says that it is because the bodies
of the spouses are in a sense not their own; they belong to each
other (cf. 1 Corinthians 7:4).

He does not mean, of course, that a husband possesses his wife's
body and a wife her husband's body in the way we possess a
thing; that would be tantamount to chattel slavery. His teaching
is more profound. It derives from the very nature of marriage.
Scripture teaches that marriage is a "one-flesh" communion of
persons (Genesis 2:24; Matthew 19:5). This "one-fleshness" is
paradigmatically actualized in and through marital intercourse.
Intercourse allows spouses to enjoy the two defining goods of
marriage: their relational union and the procreation of children
—
both realized uniquely in and through the marital act.

Spouses who choose for a time or indefinitely to refrain from
marital intercourse, refrain also from this important expression
of their one-flesh relationship, with its two goods. Because, as
St. Paul notes, this can be the cause of temptation for the
spouses (cf. 1 Corinthians 7:5), it is only justified for
serious reasons. But Catholic moral tradition has never
interpreted St. Paul's teaching as a requirement to consent to
intercourse whenever a spouse requests it. When, then, is it
legitimate to refuse one's spouse? We think it is reasonable to
conclude that it is legitimate to refuse intercourse when there
are "good reasons" to refuse.

This is not explicitly taught to our knowledge in any
authoritative Church teaching. But there is a parallel teaching
that we think implies this conclusion. There are multiple texts
teaching that refraining from procreating is only justified if
there are "good reasons." Paul VI, for example, taught in "Humanae
Vitae" that recourse to natural fertility cycles is legitimate
only if "there are iustae causae (just causes/good reasons) for
spacing births" (No. 16); John Paul II taught at an audience at
Castel Gandolfo in 1994 that "when there is a reason not to
procreate, this choice is permissible and may even be
necessary;" and Benedict XVI spoke about "grave circumstances
which make it prudent to delay the birth of children or even
suspend it" (Papal Message to "Humanae Vitae" Congress, Oct. 2,
2008).

These passages teach the norm that refraining from procreating
is legitimate only for good reasons. We think it follows that
refraining from the type of behavior through which procreation
is realized is only justified for good reasons. In other words,
because marriage is a one-flesh procreative relationship, there
must be justifying reasons (iustae causae) to refrain from
actualizing that one-fleshness with its procreativity.

We said above that an uninfected spouse is not required to have
intercourse with his or her infected spouse if there is a good
reason to avoid intercourse. We think that avoiding a gravely
harmful disease is a good reason to avoid intercourse. Although
we do not think it necessarily would be wrong for an uninfected
spouse to consent to intercourse with his or her infected
spouse; in such a case the uninfected spouse accepts as an
unintended side-effect the risk of contracting HIV in order to
share the great goods of their one-flesh unity; nevertheless,
since the harm one risks in choosing intercourse under such
circumstances is very grave, we also do not think an uninfected
spouse is under any obligation to consent to intercourse and
accept these risks.

Q: Is it all right in the eyes of the Church to withdraw oxygen
from an extremely ill patient (COPD) who requires it, if the
family requests it? Let's say, the patient's life is coming to
an end, but the family is busy and needs to return home. They
need to solidify matters of the money and belongings of the
patient and move on with their lives, and the doctor says,
"Okay, she is going to die soon, anyway." Is this okay?"
—
M.A.; Omaha, NE

William E. May offers the following response.

COPD (Chronic Obstructive Pulmonary Disease) is a serious lung
disease that makes it harder and harder for a person to breathe.
It includes chronic bronchitis, emphysema, or both. The leading
cause is cigarette smoke (see http://www.spiriva.com/consumer/about-copd/index.jsp).
Oxygen therapy is a treatment that has been shown to help people
with COPD live longer.

Today, oxygen can be delivered in many ways, from small machines
that concentrate oxygen from the air, to liquid and compressed
gas systems that are light and portable (see http://www.advair.com/copd/understand-copd/copd-treatment-options.html?src=1copd&rotation=30490752&banner=208373884&kw=p174405363&247SEM).

Many of my friends suffering from COPD have lived for more than
a decade because of the oxygen they receive in the way
described. One died last week as a result of heart failure in
his sleep (not caused by COPD) who had been receiving oxygen in
this way for more than five years during which he led a happy,
full life, driving his car in order to visit family members,
etc.

In my judgment, provision of oxygen to such persons is morally
required by the teaching of the Church insofar as the therapy
(treatment) is neither futile (useless) nor excessively
burdensome, and hence must be regarded as "ordinary" or
"proportionate" treatment.

Deliberately to withdraw this therapy as a means of ending the
person's life is an act of euthanasia that is morally condemned
by the Church.

* * *

E. Christian Brugger is a Senior Fellow of Ethics at the
Culture of Life Foundation and is an associate professor of
moral theology at St. John Vianney Theological Seminary in
Denver, Colorado. He received his Doctorate in Philosophy from
Oxford in 2000.

William E. May, is a Senior Fellow at the Culture of Life
Foundation and retired Michael J. McGivney Professor of Moral
Theology at the John Paul II Institute for Studies on Marriage
and Family at The Catholic University of America in Washington,
D.C.